Regulation 23
Health Insurance Regulations 1975
Statutory Rules 1975 No.80 as amended
made under the
Health Insurance Act 1973
Contents
23A Application for a declaration that a quality assurance activity is an activity to which Part VC of the Act applies23B Criteria in relation to quality assurance activities
23C Criteria in relation to quality assurance activities: disclosure of information
23D Criteria in relation to quality assurance activities: activities engaged in in one State or Territory
23E Criteria in relation to quality assurance activities: activities that have not been engaged in previously in Australia
23F Criteria in relation to quality assurance activities: activities that have been engaged in previously in Australia
23G Criteria in relation to quality assurance activities: review procedures / Page
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Health Insurance Regulations 1975
Regulation 23
23AApplication for a declaration that a quality assurance activity is an activity to which Part VC of the Act applies
(1)A person who wants the Minister to declare that a quality assurance activity is an activity to which Part VC of the Act applies must apply to the Minister using the form approved by the Minister for the purposes of this regulation.
(2)The form must require the applicant to give:
(a)an undertaking that the applicant will inform the Minister of a change to the purposes of the quality assurance activity to which the application relates as soon as practicable after the change occurs; and
(b)if the quality assurance activity to which the application relates is to be engaged in by a body of persons— an undertaking that the applicant will inform the Minister of any significant change to the composition or purposes of the body that is likely to affect the activity as soon as practicable after the change occurs.
23BCriteria in relation to quality assurance activities
For the purposes of paragraph 124X (3) (b) of the Act, the criteria stated in regulations 23C to 23G (inclusive) are prescribed.
23CCriteria in relation to quality assurance activities: disclosure of information
(1)A quality assurance activity must include the disclosure of information that concerns:
(a)the quality of service assessed, evaluated or studied; or
(b)the factors affecting the quality of the service.
(2)Disclosure of information:
(a)must not identify, expressly or by implication, a particular individual or particular individuals; and
(b)must take place:
(i)at times that are acceptable to the Minister; and
(ii)in a manner that is acceptable to the Minister.
(3)Subregulations (1) and (2) do not apply if the Minister is satisfied on reasonable grounds that it is not appropriate to disclose the information.
23DCriteria in relation to quality assurance activities: activities engaged in in one State or Territory
(1)The criterion stated in subregulation (2) applies if a quality assurance activity is engaged in in only one State or Territory.
(2)The Minister must be satisfied on reasonable grounds that at least one of the following paragraphs is relevant to a quality assurance activity engaged in one State or Territory:
(a)the government of the State or Territory has advised the Minister that:
(i)the activity is not subject to legislation of the State or Territory that is similar to Part VC of the Act; and
(ii)in the opinion of the government of the State or Territory, it is in the public interest that Part VC of the Act should apply to the activity;
(b)the activity includes a methodology that has not been used previously in Australia;
(c)the activity is a pilot study for the purpose of investigating whether a methodology of a particular kind can be used in Australia;
(d)the activity addresses a subject matter that has not previously been addressed in Australia;
(e)the activity has the potential to affect the quality of health care on a national scale;
(f)the activity is a pilot study for the purpose of investigating whether the activity has the potential to affect the quality of health care on a national scale;
(g)the activity is of national importance.
23ECriteria in relation to quality assurance activities: activities that have not been engaged in previously in Australia
(1)The criterion stated in subregulation (2) applies if the Minister:
(a)is considering whether to make a declaration under subsection 124X (1) of the Act in relation to a quality assurance activity; and
(b)is satisfied on reasonable grounds that quality assurance activities of that kind have not been engaged in Australia before he or she considers whether to make the declaration.
(2)The Minister must be satisfied on reasonable grounds that the application of Part VC of the Act to a quality assurance activity is necessary to make the activity effective by encouraging:
(a)the full participation in the activity of persons who provide health services; and
(b)if the activity involves the making of a recommendation to improve or maintain the quality of health services— the acceptance and implementation of the recommendation by persons who provide health services; and
(c)if the activity involves the making of a recommendation to improve or maintain the quality of health services— the participation of persons who provide health services in monitoring the implementation of the recommendation.
23FCriteria in relation to quality assurance activities: activities that have been engaged in previously in Australia
(1)The criteria stated in this regulation apply if the Minister:
(a)is considering whether to make a declaration under subsection 124X (1) of the Act in relation to a quality assurance activity (in this regulation called the activity); and
(b)is satisfied on reasonable grounds that a quality assurance activity of that kind (in this regulation called a previous activity) has been engaged in Australia.
(2)The Minister must be satisfied on reasonable grounds that the application of Part VC of the Act to the activity is necessary to make the activity effective by encouraging participation in the activity:
(a)by persons who provide health services; and
(b)to a greater extent than the participation, by persons who provide health services, in the previous activity.
(3)If the activity involves the making of a recommendation to improve or maintain the quality of health services, the Minister must be satisfied on reasonable grounds that the application of Part VC of the Act to the activity is necessary to make the activity effective by encouraging acceptance and implementation of the recommendation:
(a)by persons who provide health services; and
(b)to a greater extent than the acceptance and implementation, by persons who provide health services, of recommendations made during the previous activity.
(4)If the activity involves the making of a recommendation to improve or maintain the quality of health services, the Minister must be satisfied on reasonable grounds that the application of Part VC of the Act to the activity is necessary to make the activity effective by encouraging participation in monitoring the implementation of the recommendation:
(a)by persons who provide health services; and
(b)to a greater extent than the participation, by persons who provide health services, in monitoring the implementation of recommendations made during the previous activity.
23GCriteria in relation to quality assurance activities: review procedures
(1)The criterion stated in subregulation (2) applies if a quality assurance activity includes:
(a)the assessment or evaluation by a person of the services, skill or performance of a health care practitioner for the purpose of determining the health care practitioner’s clinical practising rights; and
(b)the making of findings on material questions of fact or law.
(2)The purposes of the quality assurance activity must include:
(a)the giving of reasons to the health care practitioner for findings:
(i)that the person makes; and
(ii)with which the health care practitioner is dissatisfied; and
(b)an entitlement for the health care practitioner to appeal to another person or body against an adverse finding made by the person; and
(c)the disclosure, by the person, of information that:
(i)is about the health care practitioner’s clinical practising rights; and
(ii)identifies the health care practitioner.
(3)In this regulation:
clinical practising rights means:
(a)a health care practitioner’s right to practise a particular profession or use particular skills in:
(i)premises at which health services are provided; or
(ii)an authority of a State or Territory; or
(b)a health care practitioner’s right to hold himself or herself out as having been certified by an association of health professionals as possessing a particular skill or competency.
health care practitioner means a person referred to in paragraph(a) of the definition of quality assurance activity in subsection 124W (1) of the Act.
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Health Insurance Regulations 1975